[Show abstract][Hide abstract] ABSTRACT: We report a case of a spontaneously reduced isolated orbital roof blow-in fracture with resolution of associated diplopia and blepharoptosis highlighting the need for a low threshold for reimaging this cohort of facial fracture patients.
The Journal of craniofacial surgery 07/2012; 23(4):1200. · 0.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reconstructive surgery for ischial pressure sore defects presents a challenge because of high rates of recurrence. The aim of this study was to describe the use of inferior gluteal artery (IGA) and posterior thigh perforators in management of ischial pressure sores with limited donor sites.
Between September 2005 and 2009, 11 patients (9 male, 2 female) with ischial sores were operated by using IGA and posterior thigh perforator flaps. The data of patients included age, sex, cause of paraplegia, flap size, perforator of flap, previous surgeries, recurrences, complications, and postoperative follow-up.
Nine IGA and 5 posterior thigh perforator flaps were used. Six patients presented with recurrent lesions, 5 patients were operated for sacral and contralateral ischial pressure sores previously. In 2 patients, IGA and posterior thigh perforator flaps were used in combination. Patients were followed for an average of 34.3 months. In 2 recurrent cases, readvancement of IGA perforator flap and gluteus maximus myocutaneous flap were treatment of choice.
Treatment of patients with recurrent lesions or multiple pressure sores is challenging because of limited available flap donor sites. In this study, posterior thigh perforator flaps were preferred in patients in whom the previous donor site was the gluteal region. IGA perforator flaps were the treatment of choice in patients for whom posterior thigh region was previously used. Alternately, preserved perforators of previous conventional myocutaneous flaps enabled us to use these perforators in recurrences.
Annals of plastic surgery 05/2011; 69(1):67-72. · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy. Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively. Especially, prematurity and diaper rash are rare predisposing factors in the pediatric population; therefore, high index of suspicion, prompt diagnosis, conservative surgery, and multidisciplinary approach are the mainstays of management in children with Fournier's gangrene.
Journal of Pediatric Surgery 01/2009; 43(12):e39-42. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Effects of hyperbaric oxygen (HBO) therapy on biointegration of porous polyethylene (PP) implanted beneath dorsal burn scar and normal skin were experimentally examined in Sprague-Dawley rats. In Group One (n=20), daily HBO treatments were given after the implantation of PP material under dorsal burn scar, whereas, in Group Two (n=20) no treatment was given following the same surgical procedure. In Group Three (n=20), PP was placed under dorsal normal skin and subsequently HBO therapy protocol was applied while Group Four (n=20) stayed without HBO treatment after the implantation. One, 2, 3 and 4 weeks after the implantations, sections were respectively taken from five rats from each group. Biointegration process and effects of HBO therapy were evaluated microscopically and the ratio of fibrovascular ingrowth (FVI) was determined for each rat. The results showed significantly superior FVI in Group One compared to Group Two and again FVI into PP under normal skin treated with HBO revealed better results against Group Four (p<0.05). Well-vascularized capsule formation and tissue integration was delayed both in Group Two and in Group Three in the first 3 weeks. In conclusion, HBO therapy enhances biointegration of PP in hypoxic burn scar areas via improving collagen synthesis and neovascularization; otherwise, it apparently delays tissue ingrowth into porous structure implanted in normal healthy tissues.
[Show abstract][Hide abstract] ABSTRACT: A series of 15 consecutive patients with various hand defects requiring flap coverage was reviewed in this study. The defects were all covered with the distally based posterior interosseous flap. Its main indications were in complex hand trauma, severe burn injury, or skin cancer ablation, either acute or postprimary. In 12 of the patients, flaps survived completely. In 3 patients, there was partial necrosis of the distal part of the flap, which did not require additional surgical procedure. Radial nerve palsy was noted in one of the cases, with a complete recovery after 3 months. Donor site was closed directly in up to 4-cm-wide flaps, while larger flaps required skin grafting. No major anatomic variation was observed. Distally based posterior interosseous flap is a reliable choice for various types and areas of hand defects, with very low donor-site morbidity, and should be more commonly considered in clinical practice.
Annals of Plastic Surgery 10/2007; 59(3):291-6. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Orbital pseudotumor is a nonspecific, idiopathic benign inflammatory process characterized by a polymorphous lymphoid infiltrate with varying degrees of fibrosis. We retrospectively reviewed the clinical presentation, management, and progress of six consecutive patients referred to our service with an initial diagnosis of orbital pseudotumor to underscore the challenge and pitfalls in managing this group of patients. Three male and three female patients, aged 27 to 74 years, presented with a variety of ophthalmologic problems, including orbital swelling, chemosis, proptosis, blepharoptosis, restricted eye motion, diplopia, and visual loss. The initial diagnosis of orbital pseudotumor was based on clinical findings, results of routine laboratory screening tests, computed tomographic and/or magnetic resonance imaging scans, and the response to corticosteroid treatment in three patients. In these three patients, the final diagnosis of orbital pseudotumor was confidently made only in one patient who remained in remission after corticosteroid therapy. The remaining two patients had Miller-Fisher syndrome and thyroid ophthalmopathy. Three other patients initially diagnosed with orbital pseudotumor underwent biopsy through an orbitotomy with comprehensive histopathologic evaluation. Two of these patients were subsequently diagnosed with non-Hodgkin lymphoma. Orbital pseudotumor belongs to a spectrum of lymphocytic infiltrative orbital conditions. It is a diagnosis of exclusion. The initial diagnosis must be regarded as provisional, and failure of complete resolution with corticosteroid therapy should heighten the index of suspicion and a biopsy should be considered. However, diagnosis may be difficult even with comprehensive histopathologic studies.
Journal of Craniofacial Surgery 10/2007; 18(5):1148-53. · 0.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Radiation-induced leiomyosarcoma of the head and neck region has been very seldom described. Herein, we report a 48-year-old male patient who developed leiomyosarcoma in his posterior neck region, which was previously radiated due to a cerebellar astrocytoma.
Journal of Craniofacial Surgery 10/2007; 18(5):1018-20. · 0.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Reconstruction of defects close to important structures where standard flaps cannot easily be used may sometimes challenge surgeons. Classic reconstructive options for such defects close to problem areas may not always yield the best result.
The authors used the triple Z flap technique for triangular defects close to problem areas in 18 patients. The defects were triangular or close to triangular in shape, and three Z flaps were planned on each side of the defect. Flaps were transposed and the defects were reconstructed without any complications.
The results were quite satisfying for both the patient and the surgeon. Neither retraction nor any distortion was observed.
The triple Z flap technique can be used in selected cases where local flap choices are scarce and it is difficult to achieve good anatomical and aesthetic results.
Plastic and reconstructive surgery 04/2007; 119(3):880-4. · 2.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Burn contractures particularly involving the joints are challenging problems which might cause severe functional impairments. Many surgical techniques have been described for use, however, an ideal method yet to be found. Releasing incision is the most common and effective way to release the wide and severe contractures but it has some drawbacks. We propose a releasing incision technique combined with four Z plasty incisions to overcome the disadvantages of traditional releasing incision technique. We successfully used our releasing incision and quadra Z technique on seven consecutive patients with burn contractures between 2003 and 2005. We modified the classical releasing incision technique by adding four Z plasties; two of them with a common base on each corner of the incision line. In this technique, limitation of the webbing following the incision is made possible by the transposed flaps and unnecessary lateral extension of the incision and the defect was avoided, i.e. maximum release gain with minimal defect was provided. Satisfactory results were achieved in seven patients treated with this technique due to significant burn contractures between 2003 and 2005 with no significant complication. We propose this technique is suitable in all patients with severe burn contractures who require releasing incision and grafting.
[Show abstract][Hide abstract] ABSTRACT: Extra-skeletal Ewing's sarcoma (EES) is an uncommon malignancy, especially in the head and neck region that may arise in various extra-osseous tissues. We report a 22-year-old male with an EES of the submandibular gland, which to the best of our knowledge, has not been described previously. The patient who underwent combined treatment with surgical resection and chemo-irradiation was disease free for 22 months but succumbed to multi-organ metastases 14 months later. This case highlights the combined diagnostic role of immunohistochemical, cytogenetic and radiological evaluation of EES. EES is an aggressive cancer that requires multidisciplinary management with wide surgical excision and adjunctive chemo-irradiation for the best outcome.
Journal of Plastic Reconstructive & Aesthetic Surgery 02/2007; 60(12):1345-8. · 1.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Arteriovenous malformation of the foot is very uncommon, and surgical closure after its treatment with embolization and total excision may be challenging for the foot surgeon, particularly in distally localized lesions. A popular method to cover these difficult wounds is free-tissue transfer, which is a highly demanding procedure. Alternatively, distally based regional flaps have been occasionally reported for clinical use in such distant foot defects. Herein, we present a 36-year-old female patient with a diagnosis of arteriovenous malformation arising in the distal medial plantar and dorsal surfaces of the right foot. After surgical resection of the vascular lesion preceded by a misapplied embolization procedure, an extended lateral supramalleolar flap was successfully transferred to the defect area, covering it completely. Functional and aesthetic outcome was satisfactory after 6 months follow-up. Extended lateral supramalleolar flap is a useful and reliable choice for distal foot reconstructions.
The Journal of Foot and Ankle Surgery 01/2007; 46(4):310-3. · 0.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The congenital upper lip sinuses are rare and they have previously been reported only in 40 cases. We have presented a case report of congenital midline upper lip sinus in an elderly age. Although the treatment modality is very easy and successful in any cases, the etiology of this rare congenital situation has been obscure and further studies should be done to find out.
Journal of Craniofacial Surgery 08/2006; 17(4):810-1. · 0.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the last few decades, microsurgery has become a reliable technique in reconstructive surgery due to numerous technical and conceptual advances. End-to-side anastomosis is currently preferred by many microsurgeons. Many recent clinical and experimental studies showed no significant difference between the slit and hole techniques for end-to-side anastomosis. We propose a different technique, based on geometrical planning of arteriotomies on both the recipient and pedicle artery. The diamond technique is easy to execute, simple, and reliable, with many advantages, and should be kept in mind in selected patients.
[Show abstract][Hide abstract] ABSTRACT: Fibroepithelial polyps (FEPs) are among the most common benign skin lesions treated frequently without submitting for histologic examination since malignant degeneration is exceedingly rare. In this case report, we describe an aggressive gross squamous cell carcinoma mass arising from a large pedunculated-type FEP located at the lower limb, which, to our knowledge, has not been reported yet.
Annals of Plastic Surgery 01/2006; 55(6):687-8. · 1.38 Impact Factor